Provider Demographics
NPI:1629737119
Name:MAGRO, CHELSEA E (MS, RD, CSG)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:E
Last Name:MAGRO
Suffix:
Gender:F
Credentials:MS, RD, CSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-0308
Mailing Address - Country:US
Mailing Address - Phone:631-662-7331
Mailing Address - Fax:
Practice Address - Street 1:450 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1555
Practice Address - Country:US
Practice Address - Phone:631-662-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86067319133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered